Ethos | 5 June 2017
Andrew Denton's series of podcasts, Better off Dead (2015-2016), presents itself as an investigation of ‘the stories, moral arguments and individuals woven into discussions about why good people are dying bad deaths in Australia, because there is no law to help them’. (Podcast 1) This very framing of the issue reveals Denton has already made up his mind about the necessity for a change in the law to permit what he calls ‘assisted dying’. Genuine research requires a position of equipoise on the part of the researcher - an agnosticism about what will be discovered. But during the eight months of investigation Denton conducted there is no evidence of an openness to other points of view, and the whole series is polemical.
And while there are many moving stories designed to elicit compassion (and a perceived need for assisted dying as a solution to the ‘problem’), there is very little critical reflection or exploration of moral arguments. Stories are powerful in influencing and stimulating moral deliberation, but they are not a substitute for it. Stories that raise questions about Denton’s position are few and quickly dismissed. The series illustrates Alasdair Macintyre’s thesis that modern ethical debate is characterised by emotivism, because we have lost the shared language and conceptual framework required for such debate to be conducted rationally.
But even more seriously, Denton seems to object to opponents of euthanasia or physician-assisted suicide even casting the debate in terms of morality. In the first podcast, he reports attending a HOPE (an anti-euthanasia group) conference. His assessment at the end of the conference: ‘Beneath the warmth of their welcome and the sincerity of their convictions was the willingness to judge those who ask for help to die in the most brutal of terms’. The evidence for this brutal judgmentalism? A statement from a presenter that euthanasia ‘takes away the moral responsibility for the moral choice of taking one’s own life’. Denton claims that this means people who request assisted dying are being called moral cowards, and an interviewee calls this ‘cruel’ and ‘persecuting’. So it seems it is unacceptable even to raise the issue of the morality of suicide.
Suicide is the elephant in the room in all these discussions. Each podcast begins with a voiceover:
This podcast is not about suicide. If you are interested in increasing your understanding of suicide and how to support someone experiencing suicidal ideation, visit the Conversations Matter or beyondblue websites.
But no disclaimer can alter the fact that the debate is about suicide. Suicide is still suicide if a doctor is involved. Suicide is suicide whether you are young, fit and healthy, or old, sick or demented. Use of the terms ‘assisted dying’ and ‘dying with dignity’ are examples of ‘euphemasia’. Advocates of euthanasia talk about ‘rational suicide’ (which they say we should support and assist), as if to distinguish it from suicide of those with mental illness, which we should prevent - and governments are pouring money into suicide prevention programs. But is there really a bright line between these two? In the Netherlands and Belgium euthanasia is now administered to relieve the unbearable and untreatable suffering of severe mental illness. Denton admits that, especially when the patient is young and fit, this is confronting, and he thought about omitting this patient’s story, as it was ‘so fraught with ambiguity and nuance that I feared it could easily be misunderstood’. He is to be commended for including it, but perhaps the problem is not that it will be misunderstood but that it will be too well understood.
Palliative care doctors would have particular reasons for being disappointed with Denton’s presentation of their discipline. Yes, after spending a week in a palliative care unit, he acknowledges their deep commitment and compassion towards their patients. But his attitude is patronising, subtly and not so subtly communicating that palliative care doctors are poorly informed, unreflective and opposed to euthanasia for outdated, ideological/religious reasons. For example, he describes the doctrine of double effect (used to justify giving adequate pain relief which might unintentionally shorten life) as introduced by the 13th century Catholic philosopher Thomas Aquinas, on the basis that (lapsing into Elizabethan English) ’only God giveth the hours and only God taketh away’. Yes, it was Aquinas who formulated the doctrine originally, but it was incorporated into English law in the twentieth century for a medical context. Denton then demonstrates a complete misunderstanding of the doctrine when he says that ‘today this is boiled down into the central tenet of palliative care: we will neither hasten nor prolong life’. The two ideas are quite separate, and the principle of neither hastening nor prolonging life has been at the heart of medicine in general, not just palliative care, since Hippocrates.
Denton ends one episode by lecturing a palliative care doctor on his duty to be better informed about the practice of euthanasia overseas, and to acknowledge that the slippery slope is not real, since it is possible to have a euthanasia regime that is safe and not open to abuse. What is the basis for this confident assertion? And on what basis does Denton assert that it ‘doesn’t make sense’ that all of the twenty-seven attempts in Australia in the past 15 years to pass euthanasia legislation have failed? Does it rest on extensive research and analysis of the evidence for how euthanasia is working in the Netherlands and Belgium? There is a large literature on this topic, including the evidence guide prepared by bioethicist David Jones in 2015 when the British parliament considered (and rejected) the legalisation of physician-assisted suicide. But instead of examining the literature, Denton ‘investigates’ for himself by visiting both countries, conducting some interviews and naively accepting the assurances he is given that everything is working wonderfully well.
In eight and a half hours, one might have expected a much deeper and more balanced exploration of this complex and difficult issue.
Denise Cooper-Clarke has special interests in professional ethics, sexual ethics and the ethics of virtue. She teaches medical ethics at the University of Melbourne and is the Zadok bioethics editor.
This review first appeared in The End of Life?, Zadok Perspectives 131, Winter 2016, pp.24-25.